Antimicrobial stewardship

Question 1

what is antimicrobial stewardship

Answer 1

Making sure patients get the right antimicrobials, when they need
them (and only when they need them).

Question 2

6 reasons we need AM stew.

Answer 2

1. massive rise in resisitance
2. drying up of antimicrobials
3. dangers of antimicrobials
4. cost of antimicrobials
5. increasing # of immunocompromised people
6. people with emotional attachment

Question 3

when did most AM resistance occur

Answer 3

in the 1990-2000 period

Question 4

why is pipeline drying up

Answer 4

• not good for business
• short prescriptions
• hard to demonstrate increased effectiveness
• patents a problem

Question 5

3 main dangers of AMs

Answer 5

1. adverse drug rxns
2. drug interactions
3. C. diff

Question 6

what is more problematic strain of C.diff

Answer 6

FQ resistant

Question 7

where is main cost of AM

Answer 7

in hospital - esp ICU

Question 8

what % of use is not necc.

Answer 8

30-50%

Question 9

what is cause of increased immunocompromised people

Answer 9

chemo, catheters, immunomod agents, HIV, dementia, transplants

Question 10

5 false AM thoughts

Answer 10

1. finish all AMs
2. think we get better when we’re viral
3. physicians don’t know what happens without a prescription
4. IV AMs are stronger
5. sicker PTs should get broader spectrum

Question 11

5 things we should know but don’t

Answer 11

1. clin. diff between cides and statics
2. cost/benefits of treating common infections
3. IVvs. oral effects
4. if starting early is most effective or not
5. ideal durations of therapies

Question 12

5 things we don’t know about cellulitis

Answer 12

1. if cephalexin or cloxacillin are sufficient in all cases
2. if 5 days of therapy suffices with β-lactam therapy
3. if patients do better with initial iv therapy
4. if any measures (e.g. compression stockings)
   reduce recurrence
5. if treating tinea pedis makes an impact

Question 13

2 things we don’t know about acute COPD

Answer 13

1. whether AMs are useful

2. which ones and for how long

Question 14

things we don’t about pneumonia

Answer 14

1. how would they do without
2. would wait and see work?
3. do PTs in hospoital need coverage not atypical
4. if dose matters

Question 15

things we don’t know about UTIS

Answer 15

1. optimal treatment for pyelonephritis
2. treatment for elderly in resistant era
3. how to manage foley cath. bacteruria

Question 16

4 ways to do AM stewardship

Answer 16

1. educate - not too helpful
2. guidelines - not too helpful
3. de-escalation - step down to narrower spectrums
4. parenteral-to-oral conversion